January 2025

posted in: Journal Club | 0

Hello COMSEP!

Wishing you well on this frosty Martin Luther King Jr. holiday (for those who celebrate)

“We must remember that intelligence is not enough. Intelligence plus character-that is the goal of true education. The complete education gives one not only power of concentration, but worthy objectives upon which to concentrate. ”
― 
Martin Luther King Jr.

Karen, Jon and Amit


A clarion call for disability rights

Jain NR, ; Stergiopoulos, E,  Addams,  A Moreland, CJ, Meeks, LM. “We Need a Seismic Shift”: Disabled Student Perspectives on Disability Inclusion in U.S. Medical Education, Academic Medicine 99(11):p 1221-1233, November 2024. DHttp://dx.doi.org/10.1097/ACM.0000000000005842

Reviewed by Abigail Nishikawa and Cassi Smola

What was the study question?

What barriers do medical students with disabilities face, and how do these barriers impact their medical education?

How was the study done?

Reflexive thematic analysis was used to review 2 cohorts (2019 and 2020) of the Association of American Medical Colleges Year Two Questionnaire that contain open-ended questions about disability for respondents who self-report a disability. Free text responses were disentangled from other survey responses and references to people and institutions were removed to protect anonymity. Themes developed from the data aimed to map categories of assistance within the educational systems. Results were divided into features of the educational system and how students navigated these systems. 

What were the results?

Student reflections represented a wide spectrum of experiences with navigating their institutions’ varying structures, processes, people, and cultures. Some responses highlighted the supportive environment, while others showed difficulty attaining accommodations. The variable responses underscore the unpredictability of barriers to education that medical students with disabilities navigate. Responses also highlighted the routes students undertook to advocate for themselves, such as creating peer communities to share strategies amongst each other. However, many students were unsure how to pursue accommodations, felt that the process was too laborious, or wanted to avoid the stigma of their peers discovering their disability. 

How can this be applied to my work in education?

The results demonstrate that while some institutions have been more successful than others to accommodate medical students with disabilities, substantial barriers persist for many students within their medical schools. Creating educational environments that are both sensitive and accommodating to individuals with disabilities is imperative. Uplifting these individuals’ voices and experiences to promote change to biased systems is a crucial step toward an equitable future in medical education. Welcoming individuals with disabilities into the medical community will enhance both professional diversity and improve patient care.

Editor’s Note: While the authors gleaned a lot from the comments in this annual survey. this is still a limited dataset based on anonymous comments of second-year students.   More is needed in terms of rich descriptions of students’ experiences across the spectrum of medical education.  For reasons discussed above, that information is hard to obtain. (JG)


Don’t fail me now

​​Liu, C., Rajagopalan, J., Wainman, B. et al. Why do instructors pass underperforming students? A Q-methodology study   BMC Med Educ 24, 1135 (2024). 

https://doi.org/10.1186/s12909-024-06126-2

Reviewed By: Brittany Lissinna

What was the study question? 

What themes and potential rationales in nursing and rehabilitation science instructors contribute to the “failure-to-fail” phenomenon?

How was the study done?

This study used Q-methodology, a unique methodology combining qualitative and quantitative approaches to explore subjectivity, identifying a range of opinions related to the study topic and using by-person factor analysis to classify participants into different groups. Participants in this study were instructors in the School of Nursing and the School of Rehabilitation Science at a Canadian university. Participants were provided statements and asked to sort them into a provided Q-sort table ranking them based on degree of agreement or disagreement. By-person factor analysis was completed creating factors that represented groups of individuals who demonstrated similar views in relation to “failure-to-fail”. 

What were the results?

57 instructors completed the Q-sort table survey. The by-person factor analysis identified three main perspectives: (1) Those in the Intrinsically Motivated group agreed that failing a student reflected their incapability as a teacher, that no student is perfect, and that failing the student would impact that student’s future; (2) The Extrinsically Motivated group reflected external forces encouraging them to pass students and a lack of institutional support when failing a student. They did not share the same concerns that failing a student would impact the student’s future; (3) Those in the Administratively and Emotionally Deterred group reflected a wish to avoid the administrative burden of failing a learner. They did not view failing a student as a reflection of their inadequacy as an educator. Participants in all three groups agreed that when they were not 100% sure about whether to fail a student, they would rather pass them. 

How can I apply this to my work in education?

Health professions educators, including those in medical undergraduate education, continue to navigate the growing concerns around “failure-to-fail”. The findings from this study bring forward some interesting distinctions between groups of educators. The distinct groups that emerged through the Q-methodology process suggest that efforts to address “failure-to-fail” will require multifaceted approaches and conversations amongst faculty. 

Editor’s Note: This is an interesting methodology where participants take a list of statements and initially divide them into three groups (agree with, disagree with, neutral); participants then rank statements within each group relative to each other and sort them into a table. This methodology addresses some of the concerns with both quantitative (e.g. Likert scale surveys) and qualitative data (e.g. interviews). It is fascinating to see the emergence of the three phenotypes described, which have face validity and certainly are thought provoking in terms of needing a diverse approach to address this increasingly challenging issue. (KFo)


Hungry for more in nutrition

Kunitsky, O., Taye, M., Feeley, K. et al. Food for thought: a qualitative assessment of medical trainee and faculty perceptions of nutrition education. BMC Med Educ 24, 1550 (2024). https://doi.org/10.1186/s12909-024-06588-4

Reviewed by Ariel Vilidnitsky

What was the study question?

What are medical student and faculty perceptions of nutrition education in undergraduate medical education (UME)?

How was the study done?

Using social learning theory, authors employed semi-structured focus groups and one-on-one interviews to understand student and faculty perceptions. In total, 25 stake-holders from Geisinger Commonwealth School of Medicine were interviewed, including five medical students, 12 UME faculty, and eight non-UME clinicians (e.g., registered dieticians). Microsoft Copilot, an AI (artificial intelligence) tool, was used to identify themes within condensed transcripts of the interviews and focus groups; the research team manually verified all AI output.

What were the results? 

Almost all participants (92%, n=23) felt physicians should receive nutrition education. However,  52% (10) were unsatisfied and 85% (11) felt physicians were not prepared to handle the nutritional needs of the patients.

Qualitative analysis produced five major themes with additional subthemes. Overall there was low self-perceived training and competence (1) despite the overall importance in medical education (2). As with any topic there were several barriers (3) including lack of space in the curriculum, insufficient faculty expertise, and limited emphasis on nutrition on board exams. Strategies for increasing content on nutrition included incorporating smaller strands of content longitudinally (4) throughout the preclinical and clinical curriculum. Participants also felt that there need to be facilitators to nutrition education such as the national medical licensing exams and governing bodies otherwise medical schools will focus on other priorities. 

How can I apply this to my work in education?

The authors cite in the introduction that up to 73% of medical schools in the United States fall short of meeting recommendations by national nutritional organizations for time medical students should spend receiving nutrition education. Comprehensive training in nutrition is paramount to a physician’s ability to prevent and manage disease, especially in pediatrics. Medical educators should consider whether adequate attention is being devoted to nutrition at their own institutions. 

Editor’s Note: While the information in this article is not really a surprise to most of us in medical education, I did like how they used Copilot to identify themes for their qualitative analysis. (AP)